Provider Demographics
NPI:1407893282
Name:RAINBOW HOSPICE AND PALLIATIVE CARE
Entity Type:Organization
Organization Name:RAINBOW HOSPICE AND PALLIATIVE CARE
Other - Org Name:PRESENCE HOSPICE - URBANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-478-7911
Mailing Address - Street 1:2380 E DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4839
Mailing Address - Country:US
Mailing Address - Phone:847-493-4835
Mailing Address - Fax:847-493-4923
Practice Address - Street 1:1501 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1006
Practice Address - Country:US
Practice Address - Phone:217-353-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2001873251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
50607OtherBLUE CROSS
141584Medicare Oscar/Certification